| NPI | 1487018206 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY 306187) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F306187) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2024-12-19 |